幽门螺杆菌与消化性溃疡关系的10年随访研究  

The relationship between Helicobacter pylori and peptic ulcer： A 10-year follow-up study

作　　者：孟灵梅[1] 周丽雅[1] 林三仁[1] 闫秀娥[1] 丁士刚[1] 黄永辉[1] 顾芳[1] 张莉[1] 李渊[1] 崔荣丽[1] 张冬红[1] 张静[1] 

机构地区：[1]北京大学第三医院消化科,100191

出　　处：《中华消化杂志》2009年第6期361-364,共4页Chinese Journal of Digestion

摘　　要：目的探讨根除幽门螺杆菌（Helicobacter pylori，Hp）后10年间十二指肠球部溃疡（DU）、胃溃疡（GU）发病情况。方法选择胃癌高发区山东烟台高陵镇随机抽样自然人群进行内镜普查，其中Hp阳性者552例均分为治疗组和安慰剂组，治疗组276例予以奥美拉唑20mg、克拉霉素0．5g和阿莫西林1．0g，每日2次口服，疗程7d。停药1个月后治疗组行13^C尿素呼气试验（13^C—UBT）证实根除成功。此后对两组在10年期间进行内镜随访（第1、5、8和10年），观察两组患者消化性溃疡发病率的变化及复发情况，同时观察两组Hp感染状态的变迁。结果治疗组消化性溃疡第1、5和8年的发病率分别为3．70％、5．86％和4．40％，均明显低于安慰剂组（12．85%、14．93％和9．39％，P值分别=0．0002、0．0017和0．0440）。随访10年间，治疗组消化性溃疡新发病例数及复发病例数均低于安慰剂组，两组间差异均有统计学意义（P值均〈0．05）。治疗组Hp再感染率较高，第10年时Hp阳性率达46．4％。根据Hp感染状态重新进行分组，结果显示随访10年间Hp阴性组消化性溃疡的发病率均低于Hp阳性组（P值均〈0．05）。结论根除Hp治疗后消化性溃疡的发病率和复发率均明显降低，消化性溃疡患者根除Hp是必要的。成功根除Hp后再感染率仍较高。Objective To investigate the incidence of peptic ulcer （duodenal ulcer and gastric ulcer） and the development of Helicobacter pylori （Hp） infection in the population during 10 years after Hp eradication. Methods Subjects were chosen from general population and performed endoscopy. Among them, the individuals confirmed to be Hp positive were randomly divided into treatment group and placebo group. The patients in treatment group received OAC triple therapy （omeprazole 20 mg, clarithromycin 500 mg and amoxicillin 1000 mg, twice daily） for one week. After that, both groups continuously followed up by endoscopy during at 1st, 5th, 8th and 10th year for incidence and relapse of peptic ulcer as well as status of Hp infection. The patients in treatment group were examined by 13^C-UBT for Hp eradication one month after the completion of treatment. Results At the 1st year, the incidence of peptic ulcer between the treatment group and placebo group were 3.7% and 12.85 % （P=0. 0002）, respectively. At the 5th year, they were 5.86% and 14.93% （P=0. 0017）, respectively. At the 8th year, they were 4.4% and 9. 39% （P = 0. 044）, respectively. The incidence of peptic ulcer of the treatment group significantly decreased after the eradication therapy compared to the placebo group. After the eradication, at the 1st year, the recurrence rates were 3.70% and 38. 1% between the treatment group and the placebo group （P=0.0027）. At the Sth year, theywere 14.81% and42.86% （P= 0.03）. At 8thyear, theywere 14.81 and 47.62% （P= 0.03）, respectively. At the 10th year, they were 25. 93% and 57.14% （P= 0. 028）. Then the recurrence rates of the treatment group significantly decreased compared to the placebo group. During the 10-year follow up study, the rate of Hp reinfection after a successful eradication in the treatment group was high, and it was 46. 4% at the 10th year. Conclusion Both the incidence and recurrence of peptic ulcer significantly decreased after Hp eradication. It is necessary of Hp eradicat

关 键 词：消化性溃疡 复发 幽门螺杆菌 随访研究 

分 类 号：R686[医药卫生—骨科学]